Invasive mole presenting as a heavily bleeding vaginal lesion 3 weeks after uterine evacuation

Gestational trophoblastic disease occurs in 1–3:1000 gestations worldwide. Up to one-fifth of complete hydatidiform moles undergo malignant transformation, with 2%–4% manifesting as metastatic disease. Of these, a third present with vaginal metastases, which can cause bleeding and discharge. We describe the case of a 49-year-old primiparous woman presenting with syncope and intense bleeding from an anterior vaginal lesion, 3 weeks after uterine evacuation for a presumed spontaneous abortion. A vaginal metastatic nodule was suspected; haemostasis was achieved with vaginal packing, precluding the need for surgical intervention. The patient was ultimately diagnosed with invasive mole with vaginal and lung metastases (stage III high-risk gestational trophoblastic neoplasia (GTN)) and started on multiple-agent chemotherapy. Two months later the lesion had regressed completely, and remission was reached 2 weeks later. Clinicians should consider the possibility of metastatic GTN with vaginal involvement whenever heavy vaginal bleeding follows a recent history of failed pregnancy.

Axillary Lymph Nodal Metastasis from Carcinoma of Unknown Primary (CUPAx)- An Orphan Disease

Metastasis to axillary lymph node occurs in adenocarcinoma or poorly differentiated carcinoma, and is a rare clinical entity that needs to be understood for management and its clinical outcome. The present case is of 72-year-old female patient who had a metastatic nodule in the axilla. No breast mass was palpable. Histology identified as metastatic adenocarcinoma, however mammography and Ultrasound Sonography test (USg) failed to detect the primary tumour. Immunohistochemistry showed that the excised lymph node was positive for Estrogen Receptor (ER) and negative for Progesterone Receptor (PR), suggesting the breast as the site for the primary tumour. Since the patient refused surgery, she was under follow-up for eight months. Now, she presented with recurrence of similar axillary swelling for two months.

A rare case of sarcomatoid carcinoma of the pancreas associated with pancreatolithiasis

Pancreatolithiasis is a risk factor for developing pancreatic cancer. We report here a rare case of sarcomatoid carcinoma of the pancreas in a 55-year old diabetic male associated with pancreatolithiasis. CT scan of abdomen revealed a large operable mass occupying the distal body and tail of the pancreas. Per-operative survey revealed a small metastatic nodule in the surface of hepatic segment IVa. Histopathology of the distal pancreatic lesion revealed sarcomatoid carcinoma. Hepatic nodule was a metastatic adenocarcinoma. Distal pancreatectomy and splenectomy was done en-mass, along with non-anatomical resection of the hepatic metastatic nodule. Combined with six cycles of chemotherapy, the patient survived a total of another fourteen months. DOI: http://dx.doi.org/10.3329/imcj.v7i1.17742 Ibrahim Med. Coll. J. 2013; 7(1): 12-15

Umbilical endometriosis: report of a case and its dermoscopic features*

Cutaneous endometriosis is a rare manifestation of endometriosis, representing 0.5% to 1% of all endometriosis cases. It can be divided into primary and secondary, when appearing spontaneously or after a surgical procedure, when it is mostly found on surgical scar tissue. Some etiologies were proposed, but none of them could entirely explain the appearance of the tumor. Differential diagnosis includes melanoma, metastatic nodule, keloid and pyogenic granuloma. Dermoscopic features are not yet well established, but there are some characteristics that suggest the diagnosis. Treatment is surgical in larger sized lesions. Malignization can occur. The screening for endometriosis is mandatory by means of gynecologic, imaging and marked-tumor evaluation. We report a case of primary umbilical endometriosis and discuss its dermoscopic aspects.